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PubMed1997

[Inhalation therapy--advantages and difficulties].

Asthma bronchiale is a very common disease in our western countries. According to the SAPALDIA study (Swiss study on air pollution and lung diseases in adults) 7% of the Swiss population suffer from bronchial asthma or have complained once or several times about asthmatic symptoms. Roughly 3% of the Swiss suffer from chronic obstructive pulmonary disease. The standard treatment for both these conditions of bronchi and bronchioles is inhalation therapy. The enormous advantages of inhalation therapy, i.e. direct action of the drugs at the site of disease and the good acceptance by patients are opposed by the difficulties for correct inhalation. All devices, pressure nebulizers, powder delivery systems or aerosol dispensers have to be explained in depth to patients to achieve optimal results. Teaching of inhalation technique is the mission of the physician, in hospitals also of physiotherapists and nursing staff. Patients with chronic pulmonary diseases are cared for by the lung leagues whose collaborators are carefully trained for treating, instructing and surveilling patients.

Administration, Inhalation↗
PubMed1992

[Efficacy of continuous isoproterenol inhalation therapy for severe asthma attacks in younger children].

The aim of this study was to evaluate the efficacy of continuous isoproterenol inhalation therapy for severe asthma attacks in younger children, compared with its efficacy in older children. We used l-body isoproterenol (Proternol L) in 31 children with 42 episodes of severe attacks. They were divided into two group according to age: 20 cases under 6 years old (Group A), and 22 cases over 7 years old (Group B). All of the patients except for one in Group B, eventually improved with this therapy. Wood's clinical scores for Group A were significantly higher than those for group B (p < 0.01). In 22 cases whose scores were 5-6, their SpO2 values at the onset of this therapy were 90.8 +/- 3.17 in group A and 92.4 +/- 3.82% in group B. The improvement time of group A (13.6 +/- 16.2 hours) was significantly longer than that of group B (2.5 +/- 5.66, p < 0.01). The nebulized isoproternol doses for group A were 0.47 +/- 0.168 and for group B 0.26 +/- 0.096 mg/kg/saline 500 ml. The dose for group A was significantly higher than that for group B (p < 0.01). We concluded that continuous isoproterenol inhalation therapy was effective even in younger children. But the degree of efficacy was slightly lower in younger children, although they inhaled higher doses of isoproterenal than older children.

Administration, Inhalation↗
PubMed2002

An exploration of the skills needed for inhalation therapy in schoolchildren with asthma in Taiwan.

BACKGROUND: Clinical observation has shown that many asthma-affected children and their parents are not familiar with appropriate techniques for inhaler use. This may result in misuse, overdose, or diminished response of the administered therapeutic drugs, or may even result in unnecessary, repeated hospitalization. Inappropriate inhalation technique is hazardous to the safety of children with asthma and unnecessarily increases costs resulting from unnecessary rehospitalization. OBJECTIVE: We designed a study to evaluate the skills needed for inhaler use among children with asthma in Taiwan. SUBJECTS AND METHODS: Schoolchildren with asthma, aged 8 to 13 years, were asked to demonstrate their inhalation technique. The inhalers used in this study were either metered-dose inhalers or dry-power inhalers. Assessment of the inhalation technique was made using a standardized inhaler checklist. A higher score indicates greater skill using the inhaler. RESULTS: This study surveyed 132 schoolchildren with asthma. Of those, only 23 (17.4%) asthmatic children who received inhalation therapy revealed good compliance with their medication regimens. No child was observed to have completed all inhaler techniques correctly. Those family members who participated in educational programs and who received instruction from health teams had higher scores for the inhaler checklist (P < 0.05). It was found that children who inhaled medication unaided had a better knowledge of asthma, and their drug inhalation technique was also more skillful (P < 0.03). By multiple regression analysis, we found that determinants of a child's skill at performing the inhalation maneuver included: number of asthma attacks within the preceding year, unaided application of inhaler therapy, older subject age, potential for subjects to receive instructions from parents regarding inhaler use, subjects reading related publications, and the family's degree of satisfaction with the physician's educational program. These variables contributed a total of 23% to variance in the subjects' inhalation technique. CONCLUSION: This study revealed that most asthmatic children being treated with inhaler medication do not use such devices appropriately. More aggressive asthma education is necessary in Taiwan.

Administration, Inhalation↗
PubMed2000

[A new spacer, Babyhaler, for BDP inhalation therapy in severe infantile asthma].

Recently, it has been recognized that airway inflammation is the most important pathogenesis of bronchial asthma, and inhaled corticosteroids therapy is effective for childhood asthma. However, using metered dose inhalers (MDI) of beclomethasone dipropionate (BDP) is difficult for infants. In this study, we administered BDP inhalation therapy with a new spacer, Babyhaler, for five cases of early childhood with severe infantile asthma that we could not control even by combination of theophylline round the clock (RTC) therapy and disodium cromoglycate (DSCG) + beta 2 stimulant (beta 2) regular use. We compared symptom score of asthma attack between the pre-treatment period (prior 2 weeks) and post-treatment period (following 8 weeks) of BDP inhalation therapy with Babyhaler. As a result, symptom score decreased significantly within 4 weeks after treatment of BDP with Babyhaler as compared with the score before treatment of BDP. These findings suggest that Babyhaler is useful for BDP inhalation therapy in infantile asthma.

Administration, Inhalation↗
PubMed1986

A standard method of intermittent inhaled therapy via a jet nebulizer.

Current methods of inhaled therapy using gas-propelled nebulizers lack standardization. The frequent use of nebulized therapy in a continuous flow may be the major reason for the inconsistency of the actual fraction of nebulized drug delivered to the patient. In an effort to achieve consistency in the amount of drug delivered to the patient, we evaluated an intermittent system of nebulized therapy, using a fingertip controlled nebulizer, in 18 adolescent asthmatics. This mode of delivery was found to be highly efficient, providing a nebulized fraction of more than 70% of the initial volumes used (0.75 to 2.6 mL). Initial volumes of 0.9 mL and above were equally efficacious, indicating no further benefit of using higher volumes. Nebulized fractions were found to be highly consistent from one patient to another (+/- 1 SD of 14.1%). We conclude that control of the actual dose delivered to the patient can be best achieved through an intermittent mode of delivery.

Adolescent↗
PubMed2000

[Role of inhalation therapy in respiratory emergencies in children].

Three modes of inhaled therapy are available for the administration of bronchodilators in acute respiratory diseases in children: spacer devices, nebulizers, inhaled powders. Principles, medications available in France, and dosages, are presented. Acute asthma is the main indication.

Acute Disease↗
PubMed2003

Inhalation therapy for bronchial asthma: strategies and targets.

Bronchial asthma is associated with symptoms, reversible airflow obstruction, airway hyper-responsiveness and inflammation along large and small airways. Inhalation therapy with bronchodilators (relievers) and anti-inflammatory agents (controllers) forms the basis of treatment for most patients with asthma of different severities. Conventionally, therapeutic efficacy is assessed on the basis of improvements in symptoms and lung function. However, airway hyper-responsiveness as a primary outcome may change therapeutic strategies. There are problems associated with this concept which need to be addressed, such as the heterogeneity of airway inflammation in the asthmatic lung. The goals for inhalation therapy should be to determine the site of airway inflammation for each degree of asthma severity, to improve inhaler technology, ensuring that the drug can reach the site of inflammation, and to improve compliance. New inhalers need to do the following: contain appropriate therapeutic agents; have particle dimensions small enough to be deposited in distal airways; and minimize the effects of incorrect inhalation and low compliance.

Administration, Inhalation↗
PubMed1999

A placebo-controlled experimental study of steroid inhalation therapy in ammonia-induced lung injury.

BACKGROUND: The use of corticosteroids in toxic lung injury caused by exposure to an irritating gas such as ammonia has not been adequately studied. OBJECTIVE: To evaluate the effects of budesonide inhalation in a rabbit model of toxic lung injury induced by ammonia. DESIGN: Randomized, blind placebo-controlled laboratory investigation employing 16 New Zealand White rabbits. Lung injury was induced by inhalation of a defined amount of aerosolized ammonia. Thirty minutes later, the rabbits were randomized to receive either inhalation therapy with 0.5 mg budesonide or placebo. After another 2 hours, a second treatment inhalation, identical to the first one, was administered. RESULTS: Airway pressures, hemodynamics, and gas exchange were measured at baseline, 5, and 15 minutes after ammonia administration and every 30 minutes during a 6-hour period after the first blind inhalation of corticosteroids or placebo. The ammonia inhalation resulted in an acute severe lung injury, detected after 15 minutes as a decrease in Pao2 from 23.3 (+/- 3.6) to 11.0 (+/- 3.6) kPa (p < 0.005) and an increase in peak airway pressure from 13 (+/- 2) to 17 (+/- 2) cm H2O (p < 0.005). During the 6-hour observation period, the blood gas parameters improved gradually in all rabbits. In comparison with placebo, budesonide did not result in improved gas exchange or reduced airway pressure levels during the observation period. CONCLUSION: In this animal model corticosteroid inhalation therapy had no effect on ammonia-induced lung injury.

Administration, Inhalation↗
PubMed2006

Respiratory adverse event profiles in cystic fibrosis placebo subjects in short- and long-term inhaled therapy trials.

The frequency and nature of adverse events (AEs) are important safety endpoints in clinical trials of therapies for cystic fibrosis (CF) subjects, yet published tables of background AE rates in the CF population are not readily available. Our objective in this study was to produce tables of respiratory AE rates for placebo subjects (pediatric and adult) for inhaled therapy trials in CF subjects. Respiratory AE rates in inhaled therapy trials were computed by combining data on placebo subjects from early-phase dosing studies and middle/late-phase studies, where placebo consisted of 4 or 5 mL of inhaled saline solution. AE rates were computed as number of events divided by number of placebo-subject days of observation, and 95% confidence intervals were computed based on a Poisson model. AEs were categorized as both broad (e.g., respiratory, reactive airway disease) and specific (e.g., cough, chest tightness, hemoptysis). In short-term studies, respiratory AE rates (95% confidence interval) were 1.1(0.7, 1.6)/person-week and 1.0(0.7, 1.4)/person-week in pediatric and adult subjects, respectively. In long-term studies, respiratory AE rates were 1.7(1.6, 1.8)/person-month and 2.2(2.1, 2.3)/person-month in pediatric and adult subjects, respectively. Stepwise Poisson models were fit to determine if baseline covariates were important in predicting AE rates. Forced expiratory volume in one second (FEV(1)) percent of predicted and age in short-term studies, and FEV(1) percent predicted and gender in long-term studies were statistically important in predicting respiratory AE rates. Although these variables were statistically significant, the models' predictive abilities were low, with adjusted R(2)'s of 0.06 and 0.12 in the short- and long-term studies, respectively. Combining placebo-subject AE data recorded from multiple CF clinical trials yields better estimates of true rates of occurrence in the CF population. The tables published from this study can be used to assist those charged with safety monitoring in CF clinical trials.

Administration, Inhalation↗
PubMed1994

Inhaled therapy in asthma: metered-dose inhaler experience.

Metered-dose inhalers are the most widely-used mode of administration of bronchodilators and anti-inflammatory agents in the treatment of asthma. However, their use is complex and about 50% of the patients do not use their metered-dose inhaler(s) properly. The most frequent errors include inadequate coordination between actuation and inspiration, rapid inspiration, absence of breathhold, and actuation of the aerosol on more than one occasion during the same inspiration. The misuse of metered-dose inhalers results in a loss of efficacy of the drug. It is, therefore, recommended that the patient be carefully trained in the proper use of metered-dose inhalers at the time of prescription. If a patient is unable to use a metered-dose inhaler properly, despite education, it may be advisable to employ a different inhalation system.

Aerosols↗
PubMed1990

[Inhalation therapy of antibiotics].

We produced experimental murine Klebsiella pneumoniae pneumonia by air-borne infection using exposure apparatus (LD50: 9.7 X 10 C.F.U./lung). The MIC value of cefazolin was 1.56 micrograms/ml, and that of gentamicin was 0.39 micrograms/ml. We treated this murine pneumonia with aerosolized antibiotics. The infected mice received inhalation of 50 mg (5 mg/ml), 100 mg (10 mg/ml), 200 mg (20 mg/ml) and 400 mg (40 mg/ml) gentamicin were alive. Survival rate of the infected mice treated with inhalation of 1000 mg (100 mg/ml) cefazolin was low, but that of them received inhalation of 500 mg (50 mg/ml) cefazolin was high. On the basis of these experiments it is suggested that aerosol of 50 mg/ml cefazolin gets to alveoli, and inhalation therapy of low level of cephems is proper for bacterial respiratory infections. Inhalation therapy of 50 mg/ml cephem for chronic bronchitis had a marked clinical effect. This proves that aerosol of cephem gets to infected bronchi.

Administration, Inhalation↗
PubMedDate not supplied

Supplemental nitrogen inhalation therapy in very low-birth-weight infants with patent ductus arteriosus.

Very low-birth weight infants with patent ductus arteriosus (PDA) accompanied by severe heart failure do not respond to indomethacine therapy. It is essential to stabilize the general condition of these infants until surgical intervention. We tried to regulate the pulmonary blood flow to control congestive heart failure by administering supplemental nitrogen inhalation therapy to six very low-birth-weight infants with PDA. After the inhalation of supplemental nitrogen gas was begun, the arterial oxygen saturation and partial oxygen pressure immediately decreased. Furthermore, the blood pH, systolic pressure, and urine output significantly increased. The infants were well stabilized. Furthermore, there were no complications related to nitrogen gas inhalation. Supplemental nitrogen inhalation therapy is an effective and feasible therapy for severe congestive heart failure in very low-birth-weight infants with PDA.

Ductus Arteriosus, Patent↗
PubMed1997

Nitric oxide inhalation therapy for an infant with persistent pulmonary hypertension caused by misalignment of pulmonary veins with alveolar capillary dysplasia.

Misalignment of pulmonary veins with alveolar capillary dysplasia (MPV) has been reported to be a rare cause of persistent pulmonary hypertension of the newborn (PPHN) and to be fatal despite extracorporeal membrane oxygenation (ECMO). A full-term female neonate with PPHN was brought to the hospital for ECMO therapy at 2 days of age. On the 14th day of life, she was extubated early after the second run of ECMO, and underwent nitric oxide (NO) inhalation therapy in the incubator. She died of catheter-related sepsis on the 61st day of life. After autopsy findings revealed MPV, the longest survival with this disease was documented. NO inhalation therapy in the incubator may provide time for lung transplantation.

Administration, Inhalation↗
PubMedDate not supplied

Inhalation therapy using a streptococcal preparation (OK-432) against bronchioloalveolar carcinoma of the lung.

OBJECTIVE: In order to inhibit the occurrence of airborne metastasis of bronchioloalveolar cell carcinoma (BAC), we tried to activate alveolar macrophages by the inhalation of aerosolized OK-432, which is a heat and penicillin-treated lyophilized preparation of the Su strain of Streptococcus pyogenes. METHODS AND RESULTS: Alveolar macrophages were obtained from resected specimens of lung cancer patients and cultured for 24 h in the presence of various concentrations of OK-432 (0.001-1 KE/ml). The cytotoxic activity against a lung cancer cell line was augmented in a dose dependent manner and reached a plateau level at 0.1 KE/ml of OK-432. Furthermore, the alveolar macrophages produced various cytokines, i.e., IL-1, TNF-alpha, and IL-6 after 72 h cultivation with 0.1 KE/ml of OK-432. Based on the in vitro experiments, six patients with intrapulmonary metastatic BAC were therefore treated by the inhalation of aerosolized OK-432. All 6 patients inhaled aerosolized OK-432 (0.1 KE/ml) twice a day for 5 days. The inhalation therapy regimen was repeated either weekly or monthly unless the tumor markedly progressed. No adverse events were observed in any patients. Either an augmentation of antitumor cytotoxicity or TNF-alpha production by the alveolar macrophages was observed in the two of three patients examined. CONCLUSION: OK-432 inhalation therapy was found to be safe and thus warrants further investigation to determine its clinical effectiveness for BAC.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1985

[The effect of beclomethasone dipropionate as inhalation therapy on the pituitary-adrenal axis in children].

The function of the pituitary-adrenal axis was investigated in ten asthmatic children (5-14 years of age) before and after administration of beclomethasone-dipropionate as inhalation therapy in a dose of 300-600 micrograms/24 hrs, during six months. Cortisol diurnal rhythm, excretion of free cortisol in 24 hours urine and stimulation of plasma-cortisol after ACTH-administration were determined. The same investigations were carried out in a comparable group of ten asthmatic children already using this inhalation therapy for more than one year. Significant differences were found comparing 08.00 h. cortisol values of the children from the first group and those who used medication for more than one year. In this first group, the ability of the adrenal glands to be stimulated by ACTH-administration after six months of medication, decreased significantly as well. These results indicate an impairment of the function of pituitary-adrenal axis during long-term treatment with inhaled beclomethasone-dipropionate. This implicates a decreased ability of the adrenal glands to react in an optimum way in stress-situations. In these patients oral or parenteral administrations of steroids should be considered earlier in stress situations like a severe asthma attack.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Inhalation therapy with magnesium sulfate and salbutamol sulfate in bronchial asthma.

Inhalation therapy with magnesium sulfate and salbutamol sulfate was applied to two groups, each consisting of 20 patients with acute asthma. The effects of inhaled magnesium sulfate and salbutamol sulfate were compared. The evaluation of patients was done using respiratory score, peak expiratory flow rate with a Wright peak flow meter, respiration rate, heart rate and blood pressure. Although magnesium sulfate's bronchodilating effect continued for approximately one hour, treatment of acute asthma using salbutamol sulfate inhalation was found to be more successful and its effect continued for six hours.

Administration, Inhalation↗